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In April of last of last year, I had a CtScan, to check on my kidneys. As the CtScan also caught the lower lobes of my chest, it was discovered that I had an 7mm perichimal (sp) scarring in my lower left lobe. It was determined to send me through another CtScan to further investigate.A an entire lung scan was effected and the scan was evaluated by a contracted lab through the VA. The doctor evaluating my scan had never seen me, but by the scan, diagnosed me with COPD!I decided to see a private practice physician, a pulmonologist, who ran me through some simple tests, looked at my scan, and opined that, not only did I not have hyperinflation of my upper lobes, but that I was actually suffering Asthma. It felt like I had a death sentence had been commuted! I have already seen the doc twice in six months. I am asked a few questions; my chest is listened to; and if I have a few questions, they are answered.Is it common practice, especially for newly diagnosed asthma cases, to be seen regularly, at first? I do have days where I am rather congested, especially when it is humid outside. Is hyperinflation of upper lobes fairly common in asthmatics?

Thanks for your Reply!

10 Replies |Watch This Discussion | Report This| Share this:Asthmatic; new to the group.In April of last of last year, I had a CtScan, to check on my kidneys. As the CtScan also caught the lower lobes of my chest, it was discovered that I had an 7mm perichimal (sp) scarring in my lower left lobe. It was determined to send me through another CtScan to further investigate.A an entire lung scan was effected and the scan was evaluated by a contracted lab through the VA. The doctor evaluating my scan had never seen me, but by the scan, diagnosed me with COPD!I decided to see a private practice physician, a pulmonologist, who ran me through some simple tests, looked at my scan, and opined that, not only did I not have hyperinflation of my upper lobes, but that I was actually suffering Asthma. It felt like I had a death sentence had been commuted! I have already seen the doc twice in six months. I am asked a few questions; my chest is listened to; and if I have a few questions, they are answered.Is it common practice, especially for newly diagnosed asthma cases, to be seen regularly, at first? I do have days where I am rather congested, especially when it is humid outside. Is hyperinflation of upper lobes fairly common in asthmatics?

How frequently you are seen by you doctor depends on your particualr situation and the doctor. Some doctors like to monitor new patients more closely until they are sure that they are well controlled. Some patients have more difficult to control asthma and need closer monitoring to make sure that all their triggers have been identified and are well controlled.

Hyperinflation is a common indicator of asthma, but it occurs in other diseases as well. It is common for asthmatics in a flare to have chest x-rays showing hyperinflation. It can clear once the flare is resolved.

Take care and God Bless.Sonya

Jeremiah 29:11 For I know the thoughts that I think toward you, saith the LORD, thoughts of peace, and not of evil, to give you an expected end... Ye shall seek me, and find [me]

How frequently you are seen by you doctor depends on your particualr situation and the doctor. Some doctors like to monitor new patients more closely until they are sure that they are well controlled. Some patients have more difficult to control asthma and need closer monitoring to make sure that all their triggers have been identified and are well controlled.

Hyperinflation is a common indicator of asthma, but it occurs in other diseases as well. It is common for asthmatics in a flare to have chest x-rays showing hyperinflation. It can clear once the flare is resolved.

I agree with Sonya on the frequency of visits. It depends on the doctor. I first saw a family practice doctor, who was not familiar with treating asthma, due to financial constraints, and he did not see me frequently enough to detect an exacerbation until finally I self referred to an allerist as my rescue drugs were not rescuing me and I was losing consciousness for a time. By that time I had insurance.

Most doctors who are allergists or pulmonologist that I've seen will see someone more frequently-typically every 2 or 3 months until they know how severe the asthma is since the management of mild asthma is very different from managing severe persistent asthma. If they don't catch that they are actually dealing with a more severe form, then their failure to act can be life threatening if the patient is not educated and action is not taken in time in the event of an emergency. If the asthma is a more severe type, then they'll typically engage in a lot of education so the patient can take over managing their own asthma. Once that happens, they typically back off on the appointments if the patient's efforts are successful and give the person an asthma action plan. In the end, though, every case is different.

So, I think it's fine to be seen regularly at first since neither you nor the pulmonologist may know your severity level and what long term treatment you may need or not need and the doctor probably (I'm guessing) wants to be sure to catch problems early.

Thanks for your Reply!

Report This| Share this:Asthmatic; new to the group.I agree with Sonya on the frequency of visits. It depends on the doctor. I first saw a family practice doctor, who was not familiar with treating asthma, due to financial constraints, and he did not see me frequently enough to detect an exacerbation until finally I self referred to an allerist as my rescue drugs were not rescuing me and I was losing consciousness for a time. By that time I had insurance.

Most doctors who are allergists or pulmonologist that I've seen will see someone more frequently-typically every 2 or 3 months until they know how severe the asthma is since the management of mild asthma is very different from managing severe persistent asthma. If they don't catch that they are actually dealing with a more severe form, then their failure to act can be life threatening if the patient is not educated and action is not taken in time in the event of an emergency. If the asthma is a more severe type, then they'll typically engage in a lot of education so the patient can take over managing their own asthma. Once that happens, they typically back off on the appointments if the patient's efforts are successful and give the person an asthma action plan. In the end, though, every case is different.

So, I think it's fine to be seen regularly at first since neither you nor the pulmonologist may know your severity level and what long term treatment you may need or not need and the doctor probably (I'm guessing) wants to be sure to catch problems early.

I was thinking about your post over the last 24 hours. I don't know where and when you served (I'm assuming, since you mentioned the VA). My sister's husband was in the war with Iraq in the early 1990s after Iraq invaded Quwait. He ended up with Gulf War Syndrome, and has been getting worse recently. I asked him if he thought it was due to exposure to depleted uranium, and he said he did not know, but his guess was it was something he inhaled since in that combat situation they could not wear full respiratory protection.

If you are wondering if you have asthma or something else based on some type of exposure, I don't know. However, what you describe in terms of hyperinflation and the number of visits is typical of asthma. I could be wrong, but my understanding is scarring normally doesn't happen unless a person has had it for years and has either really bad asthma or has not been compliant with anti inflammatory medicines. However, on the last point I'm not sure I'm correct, so others might need to correct me.

Thanks for your Reply!

Report This| Share this:Asthmatic; new to the group.I was thinking about your post over the last 24 hours. I don't know where and when you served (I'm assuming, since you mentioned the VA). My sister's husband was in the war with Iraq in the early 1990s after Iraq invaded Quwait. He ended up with Gulf War Syndrome, and has been getting worse recently. I asked him if he thought it was due to exposure to depleted uranium, and he said he did not know, but his guess was it was something he inhaled since in that combat situation they could not wear full respiratory protection.

If you are wondering if you have asthma or something else based on some type of exposure, I don't know. However, what you describe in terms of hyperinflation and the number of visits is typical of asthma. I could be wrong, but my understanding is scarring normally doesn't happen unless a person has had it for years and has either really bad asthma or has not been compliant with anti inflammatory medicines. However, on the last point I'm not sure I'm correct, so others might need to correct me.

It is easy to identify COPD by markings that may have shown up on your lungs from the CT scan. The first question I would have is, do you smoke?, as an asthma diagnosis and or COPD diagnosed in an adult instead of childhood, generally points the finger at smoking. If you do you should quit. Please be reminded that tobacco is a natural antidepressant, and you may need medications such as wellbutrin (antidepressant) as well as nicotine replacement therapy to successfully quit.

I have also treated others who insist they never smoked, but lived with extensive second hand smoke. If you personally don't smoke, but are around someone who does, ask them to take their smoking outside.

If neither of these is your case, then you should consider you may have suffered a chemical inhalation exposure at some point, that may have damaged your lungs.

As for the frequent visits to the doctor, it is not personal preference, but may be related to your supplied history. Certainly if your COPD is a result of chemical inhalation exposure, you would expect to see the doctor and have testing more frequently, especially if the substance remains unknown.

For smokers, frequent visits may indicate the choice of medication selection that is best for you is being sought. Each person eats different foods, lives different life styles, works different jobs and has different potential triggers to asthma. The goal is to find the right balance of medications to prevent asthma attacks which can be fatal. Most people do not take their asthma seriously. Most persons with COPD do not take their diagnosis seriously. I assure you, you should take both seriously to increase your quality of life, and prevent early death.

The best way to evaluate the combination of COPD and asthma is by spirometry, which is a machine you wrap your lips around and breathe into to assess the rate you can forcefully exhale, as well as the volume. Hyperinflated lungs have difficulty in exhaling air as they cannot contract well enough, so the person winds up with a prolonged expiratory phase as well as residual stagnant air. Your asthma can cause additional problems with exhaling as the bronchial tubes fill with mucous and constrict, increasing the difficulty with exhaling. The right combination of medications, to a certain extent, can reverse some of the damage, and help in preventing worsening of the condition. But both conditions will eventually worsen. So frequently seeing the doctor and being reevaluated frequently may be an effort to accomplish reversal as well as slowing progression.

The questions you should be asked relate to the cause of the asthma/COPD and your response to medications to ascertain if they are effective in helping you without creating adverse symptoms. Frequently in early asthma that has come upon a person slowly, such that they don't recognize they have lost lung capacity, is a denial of need for medications as they cannot perceive they have symptoms. You could try blowwing bubbles with a healthy person seated next to you to see how long you can actually blow bubbles compared to a healthy person. This may help identify you have lost function. By the way, blowing bubbles is a good exercise. Please make certain you know how to use your inhalers properly, as improperly used delivers substantially less medication to your lungs.

I hope this helps.

Thanks for your Reply!

Report This| Share this:Asthmatic; new to the group.It is easy to identify COPD by markings that may have shown up on your lungs from the CT scan. The first question I would have is, do you smoke?, as an asthma diagnosis and or COPD diagnosed in an adult instead of childhood, generally points the finger at smoking. If you do you should quit. Please be reminded that tobacco is a natural antidepressant, and you may need medications such as wellbutrin (antidepressant) as well as nicotine replacement therapy to successfully quit.

I have also treated others who insist they never smoked, but lived with extensive second hand smoke. If you personally don't smoke, but are around someone who does, ask them to take their smoking outside.

If neither of these is your case, then you should consider you may have suffered a chemical inhalation exposure at some point, that may have damaged your lungs.

As for the frequent visits to the doctor, it is not personal preference, but may be related to your supplied history. Certainly if your COPD is a result of chemical inhalation exposure, you would expect to see the doctor and have testing more frequently, especially if the substance remains unknown.

For smokers, frequent visits may indicate the choice of medication selection that is best for you is being sought. Each person eats different foods, lives different life styles, works different jobs and has different potential triggers to asthma. The goal is to find the right balance of medications to prevent asthma attacks which can be fatal. Most people do not take their asthma seriously. Most persons with COPD do not take their diagnosis seriously. I assure you, you should take both seriously to increase your quality of life, and prevent early death.

The best way to evaluate the combination of COPD and asthma is by spirometry, which is a machine you wrap your lips around and breathe into to assess the rate you can forcefully exhale, as well as the volume. Hyperinflated lungs have difficulty in exhaling air as they cannot contract well enough, so the person winds up with a prolonged expiratory phase as well as residual stagnant air. Your asthma can cause additional problems with exhaling as the bronchial tubes fill with mucous and constrict, increasing the difficulty with exhaling. The right combination of medications, to a certain extent, can reverse some of the damage, and help in preventing worsening of the condition. But both conditions will eventually worsen. So frequently seeing the doctor and being reevaluated frequently may be an effort to accomplish reversal as well as slowing progression.

The questions you should be asked relate to the cause of the asthma/COPD and your response to medications to ascertain if they are effective in helping you without creating adverse symptoms. Frequently in early asthma that has come upon a person slowly, such that they don't recognize they have lost lung capacity, is a denial of need for medications as they cannot perceive they have symptoms. You could try blowwing bubbles with a healthy person seated next to you to see how long you can actually blow bubbles compared to a healthy person. This may help identify you have lost function. By the way, blowing bubbles is a good exercise. Please make certain you know how to use your inhalers properly, as improperly used delivers substantially less medication to your lungs.

I see a pulminologist every 6weeks and have been seeing this one for almost 2 years. A couple times we have gone three months but then I usually end up calling her because I end up having alot of troubles. I have had asthma for 10 years and severe for 3 years. However every doctor and every case is different. It is common for asthmatics to have hyperinflation of the lungs especially if flared. I noted you said it felt like a death sentence had been commuted. I understand your frustrations its not always easy being asthmatic, in fact it sometimes down right sucks. But if you avoid your triggers and take your medications most times you can lead a normal life.

I see a pulminologist every 6weeks and have been seeing this one for almost 2 years. A couple times we have gone three months but then I usually end up calling her because I end up having alot of troubles. I have had asthma for 10 years and severe for 3 years. However every doctor and every case is different. It is common for asthmatics to have hyperinflation of the lungs especially if flared. I noted you said it felt like a death sentence had been commuted. I understand your frustrations its not always easy being asthmatic, in fact it sometimes down right sucks. But if you avoid your triggers and take your medications most times you can lead a normal life.

I just wish to clarify that I don't know if most of adult onset asthma folks have a history of smoking, as you say....but I never did smoke, and neither have my sisters.

The potential issues in me has been my parent's smoking as well as the air pollution in Houston. Harris county has been in trouble with the EPA for years, and when I asked a friend of mine whose wife was doing research in the Texas Medical Center for studies on air quality, he said she responded with, "we can't do those studies since we've been told we will be fired if we do. The companies give us a lot of money." In addition, I was told by allergists I was seeing there that moving from Houston would not help since I would just develop new allergies. Ten years after moving, I continue to have higher peak flows outside of Harris County without theophylline and prednisone than I do in Harris County with those drugs. The benefit from moving has been long term.

In addition, my current PCP told me of issues the EPA has had in Texas with getting some air stations set up and lawsuits filed by companies.

So, maybe adult onset asthma usually has smoking as a cause, but I've never heard that before although I have heard of it with COPD....but it's not always the case. As you mention, something other irritant exposure could be coming into play.

I've never smoked, and neither have either or my sisters, both of which also have some problems with asthma.

Thanks for your Reply!

Report This| Share this:Asthmatic; new to the group.I just wish to clarify that I don't know if most of adult onset asthma folks have a history of smoking, as you say....but I never did smoke, and neither have my sisters.

The potential issues in me has been my parent's smoking as well as the air pollution in Houston. Harris county has been in trouble with the EPA for years, and when I asked a friend of mine whose wife was doing research in the Texas Medical Center for studies on air quality, he said she responded with, "we can't do those studies since we've been told we will be fired if we do. The companies give us a lot of money." In addition, I was told by allergists I was seeing there that moving from Houston would not help since I would just develop new allergies. Ten years after moving, I continue to have higher peak flows outside of Harris County without theophylline and prednisone than I do in Harris County with those drugs. The benefit from moving has been long term.

In addition, my current PCP told me of issues the EPA has had in Texas with getting some air stations set up and lawsuits filed by companies.

So, maybe adult onset asthma usually has smoking as a cause, but I've never heard that before although I have heard of it with COPD....but it's not always the case. As you mention, something other irritant exposure could be coming into play.

I've never smoked, and neither have either or my sisters, both of which also have some problems with asthma.

Sorry, I meant to say that "sometimes other irritant exposure" as opposed to "something other irritant exposure". As you say, though, sometimes it's not that the individual asthmatic is smoking but others are smoking or their is air pollution from cars or oil refineries.

Thanks for your Reply!

Report This| Share this:Asthmatic; new to the group.Sorry, I meant to say that "sometimes other irritant exposure" as opposed to "something other irritant exposure". As you say, though, sometimes it's not that the individual asthmatic is smoking but others are smoking or their is air pollution from cars or oil refineries.

Sorry, I just reread your post. Of course, if a person smokes they should quit since it would be an aggravating factor for asthma. You could be right, I just never heard a person say that smoking is a major cause of adult onset asthma appearing in the first place (as opposed to be an aggravating factor once the disease is present) in the same way I hear of it with COPD. Perhaps I misunderstood you, though.

Thanks for your Reply!

Report This| Share this:Asthmatic; new to the group.Sorry, I just reread your post. Of course, if a person smokes they should quit since it would be an aggravating factor for asthma. You could be right, I just never heard a person say that smoking is a major cause of adult onset asthma appearing in the first place (as opposed to be an aggravating factor once the disease is present) in the same way I hear of it with COPD. Perhaps I misunderstood you, though.

Are there any over the counter meds or sprays that can be bought at a place like Walgreens without a prescription that will help a person with COPD? Drrugs like Advair and some others tend to be expensive, and I am rather watching my spending lately.

Thanks for your Reply!

Report This| Share this:Asthmatic; new to the group.Are there any over the counter meds or sprays that can be bought at a place like Walgreens without a prescription that will help a person with COPD? Drrugs like Advair and some others tend to be expensive, and I am rather watching my spending lately.

I am not sure you will find any over the counter medications for asthma or COPD. But I do know that green tea, and I believe regular tea, as well as cocoa and quality chocolate contain theophylline which is used to treat asthma conditions.

My mother and two sisters all are treated for asthma. I am the only one who is not. I smoked 1/4 pack cigarettes age 15-21, and both parents smoked. I however was the only child who could not drink enough tea, and still consume about 8 tea bags of hot tea or 1-2 pitchers of ice tea a day. If I am not drinking those, it is either coffee, cocoa or water. I have often considered this to be the intelligence of my brain, liking the feedback of this low dose of theophylline. Cravings for food items sometimes exist to meet a bodily need.

Thanks for your Reply!

Report This| Share this:Asthmatic; new to the group.I am not sure you will find any over the counter medications for asthma or COPD. But I do know that green tea, and I believe regular tea, as well as cocoa and quality chocolate contain theophylline which is used to treat asthma conditions.

My mother and two sisters all are treated for asthma. I am the only one who is not. I smoked 1/4 pack cigarettes age 15-21, and both parents smoked. I however was the only child who could not drink enough tea, and still consume about 8 tea bags of hot tea or 1-2 pitchers of ice tea a day. If I am not drinking those, it is either coffee, cocoa or water. I have often considered this to be the intelligence of my brain, liking the feedback of this low dose of theophylline. Cravings for food items sometimes exist to meet a bodily need.

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